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Monday, April 9, 2012

The ICD-10 proposed delay was published for inspection in the Federal Register today with a 30-day comment period starting from the date of publication in the Federal Register (expected to be 4/17). Included also in the publication were proposals for a Health Plan Identifier and changes to the requirements for a National Provider ID for certain providers.

One question I'm sure to get if I don't address it now is how the proposed delay would impact Meaningful Use Stage 2. Two ICD-10 vocabularies are included in the current Meaningful Use 2014 Certification Criteria

ICD-10-PCS is one of the two standards allowed under the 2014 criteria (the other is CPT-4/HCPCS) for recording procedures, and immediately follows the links above.

ICD-10-CM is also use to record preliminary cause of death in the inpatient setting [see §170.314(a)(3)(ii)].

So, we have 7 requirements in the 2014 Criteria that an EHR must satisfy in order to be certified for Meaningful Use under the 2014 criteria.

As a meaningful User, if your reporting period starts in Calendar Year 2014 (for eligible providers), or in Fiscal Year 2014 (October 1, 2013) for Hospitals, you must be using an EHR that has been certified to the 2014 criteria.

Without the delay, your EHRs would have been ICD-10 capable on October 1, 2013 already. With the proposed delay, your EHR must support both ICD-9 and ICD-10 codes. This is because meaningful use requires summaries to use ICD-10, but your payers would require you to use ICD-9 (until the new date October 1, 2014).

This creates challenges for EHR vendors because they would have to support both requirements under the current set of proposals. If the Meaningful Use rule were to change to use the current set of billing codes, that would also cause challenges because a vendor would either have to certify that they support both in one system, or go through "gap certification" to meet the requirements of the ICD-10 change over.

This would seem to have pretty severe impacts on a commercial EHR implementations. The effects of the intersection of the two proposed regulations does not appear to have been considered in the regulatory impact analysis.

According to what I've heard about
Encounter diagnoses with respect to meaningful use, they were meant to be used clinically. Given that, it seems logical that they should use the same vocabularies as the problem list (SNOMED CT at present), rather than billing vocabularies. Making this change would simplify things somewhat for developers and implementers of Certified EHR technology. But that only addresses issues around encounter diagnosis and preliminary cause of death. It doesn't address issues around procedures, because EHRs would still have to cut over in October for hospitals.

Switching to PCS sooner would alleviate the latter issue, but as the proposed rule indicates, this still creates a double-switchover problem for hospitals.